Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model.

MedLine Citation:

PMID:
23051839
Owner:
NLM
Status:
Publisher

Abstract/OtherAbstract:

BACKGROUND: -Several percutaneous circulatory support systems have been recently introduced into clinical practice for the treatment of cardiogenic shock or refractory non-tolerated ventricular tachycardia, in support of high-risk catheter interventions and occasionally, cardiopulmonary resuscitation. To date, however, a direct comparison of the available systems has not been performed. METHODS AND RESULTS: -Adult female pigs (weight 50 kg to 60 kg) were used throughout the experiment. Under deep anesthesia and mechanical ventilation, three percutaneous circulatory support systems were compared: (i) right atrium - aorta (RA-Ao), extracorporeal membrane oxygenation (N=4); (ii) left atrium - aorta (LA-Ao), TandemHeart system (N=4); (iii) left ventricle - aorta (LV-Ao), Impella 2.5 system (N=4), and (iv) LV-Ao + norepinephrine (NE) 0.1 μg/kg/min (N=4). Hemodynamic efficacy (mean arterial pressure [MAP]) was measured at three specific conditions: ventricular pacing (VP) 200 beats/min and 300 beats/min, and ventricular fibrillation. While no or only non-significant differences were found among the systems at VP 200 beats/min and VP 300 beats/min, under ventricular fibrillation, the RA-Ao system was significantly the most efficacious, followed by the LA-Ao system, and the LV-Ao system (P<0.001). However, the LV-Ao system with NE still maintained MAP comparable with the LA-Ao system. CONCLUSIONS: -Differences were seen in the hemodynamic efficacy of available percutaneous circulatory support systems - particularly under the most severe hemodynamic condition, ventricular fibrillation.